Individual
AUSTIN FREDERICK TIESENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4461
Mailing address
48 ROYAL VALE DR, OAK BROOK, IL 60523-1643
(312) 890-1685
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/21/2023
Last updated
02/06/2024
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